Provider Demographics
NPI:1710457262
Name:PRITTIPAUL, BRIJESH
Entity Type:Individual
Prefix:
First Name:BRIJESH
Middle Name:
Last Name:PRITTIPAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10741 WATSON PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2510
Mailing Address - Country:US
Mailing Address - Phone:347-367-0409
Mailing Address - Fax:
Practice Address - Street 1:10741 WATSON PL
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2510
Practice Address - Country:US
Practice Address - Phone:347-367-0409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver